Roladan: 6 weeks off escitalopram and 3.5 months off mirtazapine

[Roladan]

It was the end of May when I took the last dose of Mirtazapine, after 2 years of treatment and 6 months of gradual tapering from 30mg to 0. Soon after, my psychiatrist decided I should quit abruptly my 5 mg of Escitalopram, "an insignificant dose to taper", as she said. I tapered it however for one month, then quit taking it. It's been 6 weeks now since I last took Escitalopram and 4 and a half months since I took my last Mirtazapine.

 

I felt quite fine for the last months. Possibly, my cardio, yoga, meditation and weekly CBT sessions helped out. 

The only withdrawal effect I noticed throughout this period was bad sleep (around 5 hours of sleep per night, with tormenting sensations and many awakenings).

However, for the last 10 days, my sleep has worsen even more. I have now early morning insomnia. I wake up in the middle of the night, with a panicky feeling, and can't go back to sleep. Taking a half of sleeping pill sometimes helps me get back to sleep, other times a full pill doesn't help. 

 

Early morning insomnia is a symptom I experienced before, when quitting Sertraline and Risperidone, and it lasted for 2-3 months. But now, after reading the experiences of some people who went through 4 years of insomnia after quitting Escitalopram, I can't stop thinking what if this this round of insomnia will take a lot more than before. 

 

Should I return to a small dose (2 mg of Escitalopram) for a while, then try to taper it slowly, or go on and see how things are developing?

 

Thank you.

 

[Go2zero]

Hi Roladan,

 

Welcome to this support site. Before we can answer your questions, please give us more information first. Good that you came to this website. There is a lot of knowledge to be found and shared here. Also the members can support each other here.

 

Can you please give us specific information about your drug history for all drugs you are on and have been on, especially for the past 18-24 months?  It would be especially helpful to have the details of your drugs in a concise list (no symptoms), only drug names, specific dates (as best you can say for example early March if you don't recall the day) and dosages of each medication decrease or increase.  Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

https://www.survivingantidepressants.org/topic/18343-please-summarize-your-withdrawal-history-in-your-signature/

 

When did you start the escitalopram?
Why did you stop the Mirtazapine and start the escitalopram?

 

On 9/9/2021 at 8:44 AM, Roladan said:

However, for the last 10 days, my sleep has worsen even more. I have now early morning insomnia. I wake up in the middle of the night, with a panicky feeling, and can't go back to sleep. Taking a half of sleeping pill sometimes helps me get back to sleep, other times a full pill doesn't help. 

 

This is a very common WD effect of most SSRI's. You are right. Lots of Escitalopram users experience this. And very often this starts 2-4 months after stopping a drug or after a too fast taper.

 

Most often one can get sleep for 2-3 hours and wakes up then. Sleeping pills most often only work for getting into sleep. Not for sleeping all night. Most people therefor have no positive effect of the sleeping pills. Furthermore these sleeping pills are addictive and can make the overall (withdrawal) situation worse.  We advise NOT to take sleeping pills. 

 

When you have made your signature and answered the questions, we will be back to you. Then we can say more if and how reinstatement could be appropriate in your case.

 

Here is some interesting information:

 

https://www.survivingantidepressants.org/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/?tab=comments#comment-525233

 

https://www.survivingantidepressants.org/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/?tab=comments#comment-33809

 

 

[Roladan]

Thank you, Go2zero

 

I edited my signature, as you suggested

[Go2zero]

OK, thank you for the signature.

 

I see you have been taking escitalopram next to Mirtazapine for a period of 2 years. 5 mg of escitalopram is not a low dose. Escitalopram is a very very potent SSRI!

 

At 5 mg is blocks 72% of the serotonin receptors, whereas 10mg block 78%

 

On 9/9/2021 at 8:44 AM, Roladan said:

Soon after, my psychiatrist decided I should quit abruptly my 5 mg of Escitalopram, "an insignificant dose to taper", as she said.

Why did your psychiatric decided you should quit abruptly? What was the reason for that?

 

[Roladan]

She said that "it's an insignificant dose to taper, it's like placebo. And it's summer, a good time to stop the treatment".

 

But, in fact, she doesn't favor tapering. She's my third psychiatrist and they all use the same method: cut the pill in half, take another 10 days, then stop.

 

 

[Go2zero]

15 minutes ago, Roladan said:

She said that "it's an insignificant dose to taper, it's like placebo. And it's summer, a good time to stop the treatment".

 

But, in fact, she doesn't favor tapering. She's my third psychiatrist and they all use the same method: cut the pill in half, take another 10 days, then stop.

 

 

Yes, most doctors do not have a clue.....

 

In this chart you can see how "insignificant" this 5mg dose is....

 

% of 1 pill(20 mg)	Dosage in mg Escitalopram	% blockage serotonin receptor (SERT)
100	10	78
50	5	72
25	2,5	62
12,5	1,25	48
10	1	44
7,5	0.75	37
5	0,5	29
4	0,4	25
3	0,3	20
2	0,2	14,5
1,5	0,15	11
1	0,1	8
0,5	0,05	4
0,25	0,025	2
0,1	0,01	0,9
0,05	0,005	0,5

 

 

Escitalopram is a very potent drug, If one goes off to fast, very heavy withdrawal Symptoms may occur

 

https://www.survivingantidepressants.org/topic/406-tips-for-tapering-off-escitalopram-lexapro/

 

The only good and most safe method is SLOWLY tapering

 

Read here why and how: 

 

https://www.survivingantidepressants.org/topic/1024-why-taper-by-10-of-my-dosage/

 

Since you already stopped (CT) 5mg escitalopram 6 week ago and are starting to feel WD symptoms, I would try to reinstate at 1mg as soon as possible. See what that does. I needs at least 1 week to see if that helps.

 

https://www.survivingantidepressants.org/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/?tab=comments#comment-33809

 

 

[Roladan]

Thank you, I will do that right away. Just one causion. Perhaps it will sound silly, but I have to say it: I had my second Pfizer vaccine Tuesday, won't it interfere with my first dose of escitalopram?

[Go2zero]

31 minutes ago, Roladan said:

I had my second Pfizer vaccine Tuesday, won't it interfere with my first dose of escitalopram?

 

Hard to say. Everybody can react different. How did you feel after the first dose of the Pfizer vaccine?

 

You can read this thread. Maybe you find some help there. https://www.survivingantidepressants.org/topic/22542-coronavirus-covid-19-covid-19-vaccine-psychiatric-drug-tapering-withdrawal/page/13/#comments

 

[Roladan]

I felt well after both doses, just a pain in my shoulder for 2-3 days. I also had COVID in March this year (when I was on Escitalopram), perhaps that made the vaccine easier for me.

[Go2zero]

In that case I think you could start reinstatement if you want.

[Roladan]

Thank you, I already did that one hour ago. No allergic or other bad reactions, so far. 

[Roladan]

I don’t know if it’s related to reinstating escitalopram, the Pfizer vaccine or simply the evolution of the withdrawal symptoms, but my insomnia got worse. I can’t sleep at all now. Not even with a lot of benzos. 

 

I did some blood tests, hoping for some magnesium deficiency. Because my left hand has continuous spasms, and my left-hand fingers are numb for more than 3 weeks. I also have nausea and no appetite. But no luck, magnesium seems alright.

 

I went to the emergency room and wanted to hospitalize myself, but the doctor’s wanted to switch me to venlafaxine and didn’t admit I could have a withdrawal symptom. So, I left. For now. Clearly, in this rhythm, I will eventually end up on a hospital bed, or worse.

 

My therapist says it could be a burnout. I had indeed perhaps the most exhausting summer of my life, and no vacation whatsoever. My therapist says perhaps I had the misfortune to go through it without my antidepressant.

 

My wife is crying more than I do. I see no way out.

 

I see myself in the situation of another member, LiaJ.

June-August 2017 tapered off Celexa (5mg)

October 2017 Hospitalized for insomnia (quit sleeping entirely)

 

Should I try to go for more on my Escitalopram dose? I don’t if it’s acting against me or it’s simply still insufficient. I’m lost. 

 

Any tip will be cherished right now. Thank you.